Disparities in breast cancer mortality exist between Hispanics and non-Hispanic white (NHW) women. The goal of the proposed research is to understand how aspects of the health care delivery system and quality of care relate to breast cancer diagnosis and treatment among Hispanic women. Each of the three specific aims are distinct projects that focus on the macro-level factors (policy, long-term adjuvant treatment, and quality of medical care) that have the potential to reduce disparities in breast cancer mortality. The studies employ both qualitative and quantitative methodologies. The first aim is to estimate the rates of breast cancer mortality and lifetime costs for Hispanic women who undergo biennial mammography screening beginning at age 40. A simulation model will be used to examine various screening regimens using inputs, risks, probability, and costs specific to low-income Hispanic women. Second, we will determine the unique factors associated with adherence to adjuvant therapy among Hispanic women with breast cancer. In this qualitative study, we will conduct focus groups and in-depth interviews with Hispanic women at various stages of breast cancer diagnosis, treatment, and follow-up. The final study will determine the health care utilization patterns and costs for Hispanic women with a patient center medical home (PCMH) who are diagnosed with breast cancer. I will construct a generalized linear regression model using data from the Medical Expenditure Panel Survey (MEPS) and examine the effect of differences in utilization of medical care and costs between Hispanic and NHW women with a patient-centered medical home. The proposed study fits well within the National Cancer Institute goals, which is to identify and address underlying causes of racial and ethnic cancer disparities. The hope is that findings from these studies can be used to decrease the rate breast cancer mortality among Hispanic women. The results of Aim 1 will provide information on the rates of breast cancer mortality among Hispanic women who begin biennial mammography screening at age 40 versus age 50. The results of Aim 2 will identify factors related to medical care and sociocultural factors that are important in determining whether Hispanic women adhere to adjuvant therapy following initial treatment for breast cancer. Results from Aim 3 will determine the importance of a patient- centered medical home that are important in improving quality of medical care, controlling costs, and increasing necessary utilization of medical services. Findings from the research will inform future interventions to inform policy recommendations, increase adherence to the benefits of evidence-based adjuvant therapy, and improve the quality of medical care. Ultimately, the goal is to increase breast cancer survival among Hispanic women. PUBLIC HEALTH RELEVANCE: Hispanic women are more likely to die from breast cancer at every stage of diagnosis compared to non- Hispanic white women. The disparity in breast cancer mortality may be attributed to the contextual and environment factors such as guideline recommendations, adherence to adjuvant therapy, and the quality of medical care. This research proposal will help to identify important avenues for intervention to lessen the burden of disease among this population.